The tenth annual report from the National Registry of Deliberate Self Harm was published in July 2012.1 The report contains information relating to every recorded presentation of deliberate self-harm to acute hospital emergency departments in 2011, giving complete national coverage of cases treated.

There were 12,216 recorded presentations of deliberate self-harm, involving 9,834 individuals, in 2011. This implies that one in five (2,382, 19.5%) of the presentations were repeat episodes. The rate of presentations decreased from 217/100,000 of the population in 2010 to 215/100,000 in 2011, a 4% decrease.

Concordant with previous reports, 48% of self-harm presentations in 2010 were men and 47% were aged under 30 years. Four hundred and seventy-three (4%) self-harm presentations were living in homeless hostels or had no fixed abode, a 53% increase on the number of such presentations in 2010. Presentations peaked in the hours around 10pm and were highest on Sundays and Mondays; 31% of episodes occurred on these two days. There was evidence of alcohol consumption in 39% (4,773) of all presentations and this was more common among men (40%) than women (38%).

Drug overdose was the most common form of deliberate self-harm, occurring in 69% (8,409) of all such episodes reported in 2011. Overdose rates were higher among women (75%) than among men (62%). In 73% of cases the total number of tablets taken was known; an average of 30 tablets was taken in these cases. The average among men was 32 tablets and among women 29 tablets. Forty-three per cent of all drug overdoses involved a minor tranquilliser (most commonly benzodiazepines), 26% involved paracetamol-containing medicines, 22% involved anti-depressants or mood stabilisers (most commonly SSRIs) and 10% involved a major tranquilliser. The number of deliberate self-harm presentations involving street drugs decreased by 27% (to 479) in 2011 when compared to 2010 (645). Men (10%) were much more likely than women (3%) to self-harm using street drugs.

The next steps, or referral outcomes for the deliberate overdose cases were: 46% discharged home; 33% admitted to an acute general hospital; 8% admitted to psychiatric in-patient care; a small proportion (1%) refused admission to hospital; and 13% discharged themselves before receiving referral advice.

The report provides information on what is being or can be done to reduce the number of self-harm cases. In January 2012, the National Office for Suicide Prevention established a National Working Group on Restricting Access to Means with a priority on restricting access to minor tranquillisers. The authors recommend that this working group also review the implementation of the paracetamol legislation and prescribing patterns of SSRIs.

The authors report that alcohol continues to be one of the factors associated with the higher rate of self-harm presentations on Sundays, Mondays and public holidays, around the hours of midnight. These findings underline the need for on-going efforts to:

• intensify national strategies to increase awareness of the risks involved in the use of alcohol starting at pre-adolescent age;

• intensify national strategies to reduce access to alcohol and drugs;

• enhance health service capacity at specific times and increase awareness of the negative effects of alcohol use such as increased depressive feelings and reduced self-control;

• arrange active collaboration between the mental health services and addiction treatment services in the best interest of patients who present with dual diagnosis (psychiatric disorder and alcohol/drug abuse).

The authors report that there was variation in the next care recommended to deliberate self-harm patients, and in the proportion of patients who left hospital before a recommendation, from 8% in the Southern Hospitals Group to 24% in the Dublin North East Hospitals Group. In 2012, a sub-group of the National Mental Health Clinical Programme Steering Group produced National guidelines for the assessment and management of patients presenting to Irish emergency departments following self-harm. The authors recommend ‘that these guidelines be implemented nationally as a matter of priority’.